Monitoring trends in socioeconomic health inequalities: it matters how you measure
Monitoring trends in socioeconomic health inequalities: it matters how you measure
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DOI：
10.1186/1471-2458-8-66
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发表时间：
2008-02-20
影响因子：
4.5
通讯作者：
Lynch, John W.
中科院分区：
文献类型：
--
作者：
Khang, Young-Ho;Yun, Sung-Cheol;Lynch, John W.
背景：比值比（Odds ratio， OR）是衡量健康不平等的一种相对指标，在以往的研究中经常被用来描述健康和健康行为的不平等趋势。由于当结果流行率相当高时，OR并不是流行率（PR）的良好近似值，因此，当结果变量（如吸烟或健康状况不佳）流行率相对较高且随时间变化很大的数据中使用OR趋势时，可能会出现一个重要问题。本研究旨在比较优势比（OR）和患病率比（PR）的时间趋势，以检验吸烟社会经济不平等的时间趋势。方法：对1999 ~ 2006年3次全国社会统计调查中25 ~ 64岁的147805名（男性71793人，女性76017人）进行分析。社会经济地位指标为职业等级和教育程度。结果：男性职业阶层的ORs趋势p值不显著，pr趋势p值显著。在女性中，OR趋势的p值与PR趋势的p值相似。在男性中，对数二项回归的RII呈显著上升趋势，而逻辑回归的RII在年份之间保持稳定。在女性中，逻辑回归和对数二项回归的RIIs趋势产生了相似的p值水平。结论：衡量社会经济健康不平等趋势的不同方法可能导致相对不平等是增加还是减少的不同结论。当结果的流行率相对较高且流行率随时间变化很大时，ORs的趋势可能夸大或低估了健康方面相对不平等的趋势。
Background: Odds ratio (OR), a relative measure for health inequality, has frequently been used in prior studies for presenting inequality trends in health and health behaviors. Since OR is not a good approximation of prevalence ratio (PR) when the outcome prevalence is quite high, an important problem may arise when OR trends are used in data in which the outcome variable (e. g., smoking or ill-health) is of relatively high prevalence and varies significantly over time. This study is to compare time trends of odds ratio (OR) and prevalence ratio (PR) for examining time trends in socioeconomic inequality in smoking.Methods: A total of 147,805 subjects (71,793 men and 76,017 women) aged 25-64 from three Social Statistics Surveys of Korea from 1999 to 2006 were analyzed. Socioeconomic position indicators were occupational class and education.Results: While there were no significant p values for trend in ORs of occupational class among men, trends for PRs were significant. In women, p values for OR trends were similar to those for PR trends. In males, RII by log-binomial regression showed a significant increasing tendency while RII by logistic regression was stable between years. In females, trends of RIIs by logistic regression and log-binomial regression produced a similar level of p values.Conclusion: Different methods of measuring trends in socioeconomic health inequalities may lead to different conclusions about whether relative inequalities are increasing or decreasing. Trends in ORs may overstate or understate trends in relative inequality in health when the outcome is of relatively high prevalence and that prevalence varies significantly with time.